Organization
LOUISVILLE GERIATRIC ASSOCIATES
Active
Other names
Wall Street Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MUHAMMAD I MASROOR (OWNER)
(812) 288-8360
Entity
Organization
Contact information
Practice address
443 SPRING ST STE 200, JEFFERSONVILLE, IN 47130-4494
(812) 288-8360
(812) 288-8375
Mailing address
443 SPRING ST STE 200, JEFFERSONVILLE, IN 47130-4494
(812) 288-8360
(812) 288-8375
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300025251
—
IN
Enumeration date
12/09/2009
Last updated
07/17/2024
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